Wellness Check: Nutrition

Positioning food and restaurant options in order of ascending energy content promotes lower-energy meal choices

1. In this randomized controlled trial, listing food and restaurant options in order of ascending energy content reduced the energy content of participants’ meal choices compared to the control.

2. Furthermore, repositioning food and restaurant options based on energy content reduced the final price of participants’ choices.

Evidence Rating Level: 1 (Excellent)

Consuming meals at restaurants or through delivery take-outs has been associated with higher energy consumption and body mass index (BMI), which can have adverse long-term health effects. The way in which food options are presented may impact food selection and purchasing choices. However, the impact of changing the presentation of food choices on consumption has yet to be thoroughly tested. Therefore, the present study aimed to investigate whether repositioning food or restaurant options in a food delivery platform based on energy affects the energy content of meal choices.

The study included 9,003 adult participants from the UK. Participants were included if they were 18 or older and used food delivery platforms. Participants who failed attention checks or had hypothetical orders containing more than 4,000 or fewer than 150 kcals were excluded. Participants were asked to make choices on a simulated food delivery platform that included 21 restaurants and 570 food or drink items. Participants were randomized into either a control condition that listed food and restaurant choices randomly or one of four intervention groups: 1) food options displayed in ascending order of energy, 2) restaurant options displayed in ascending order of average energy content per main meal, 3) intervention 1 and 2 combined, and 4) restaurants positioned as in intervention 2, but food positioned based on kcal/price, with low-calorie, high-price foods listed at the top. The primary outcome was the average energy content and price of participants’ meal choices in each group.

The results demonstrated that all four interventions led to a decrease in the energy content of the participants’ meal choices compared to the control. Repositioning both food items and restaurants based on energy led to the greatest energy reduction, while repositioning only food choices led to the least reduction in energy. Furthermore, all interventions except repositioning by kcal/price led to a reduced basket price. The study was limited by its simulated nature, which may have impacted participants’ choices, as they were not actually receiving the food they selected. Nonetheless, the results suggested that thoughtful repositioning of food options could be a wide-scale intervention to promote healthier food choices.

Diets high in processed foods may be associated with an increased risk of depressive symptoms

1. In this multicohort study, adherence to dietary patterns rich in processed foods was associated with an increased risk of developing depressive symptoms.

2. However, adherence to a traditional Chinese diet or a healthy dietary pattern was associated with a reduced risk of depressive symptoms. 

Evidence Rating Level: 2 (Good)

Depression is a common mental health disorder with high morbidity which can be influenced by several environmental factors. Several studies have suggested that modifiable lifestyle factors, such as the intake of single foods or nutrients, could play a role in preventing the development of depressive symptoms. However, whether more generalized dietary patterns are associated with the incidence of depressive symptoms has not been well studied. Therefore, the present study aimed to investigate the impact of dietary patterns on depressive symptoms.

The study included participants from 2 large prospective cohort studies: the Tianjin Chronic Low-grade Systemic Inflammation and Health (TCLSIH) cohort study, which included 7,094 adult participants living in Tianjin, China, from 2013 to 2019, and the UK Biobank cohort study, which included 96,810 adult participants from the UK between 2006 and 2010. Participants were excluded if they had missing dietary data or a history of cardiovascular disease, cancer, or depressive symptoms at baseline. Participants’ dietary patterns were identified using validated food frequency questionnaires. Depressive symptoms were assessed using the Zung Self-Rating Depression Scale (SD) in the TCLSIH cohort or hospital inpatient records in the UK Biobank study. The primary outcome was the association between various dietary patterns and depressive symptoms.

The results demonstrated that in the TCLSIH cohort, following a traditional Chinese dietary pattern was associated with a lower risk of depressive symptoms. In comparison, diets high in sugar or processed animal offal were associated with a higher risk of depressive symptoms. Similarly, following a dietary pattern high in processed food was associated with a higher risk of depressive symptoms in the UK Biobank cohort. Overall, in both cohorts, a healthy dietary pattern was associated with a reduced risk of depressive symptoms. The study was limited by the measure of depressive symptoms in the TCLSIH cohort, which was not based on diagnostic psychiatric interviews. Nonetheless, the results suggested that dietary patterns could affect the risk of developing depressive symptoms.

Consuming some polyunsaturated fatty acids may help slow the progression of amyotrophic lateral sclerosis

1. In this prospective cohort study, higher blood levels of the polyunsaturated fatty acid (PUFA), alpha-linolenic acid (ALA), were associated with slower disease progression and lower risk of death in patients with amyotrophic lateral sclerosis (ALS).

2. However, higher levels of palmitic acid, a monounsaturated fatty acid, were associated with a higher risk of death in ALS patients.

Evidence Rating Level: 2 (Good)

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with no effective disease reversal or curative therapeutics. In large cohort studies, polyunsaturated fatty acids (PUFAs) have demonstrated a protective role in neuronal survival and neuroinflammation. However, whether individual PUFA levels are associated with ALS disease progression and risk of death has not been well studied. Therefore, the present study aimed to investigate the association between PUFAs and clinical progression in ALS patients.

This prospective cohort study included 449 adult ALS patients (65% men) from the EMPOWER randomized control trial that evaluated dexpramipexole treatment in ALS patients. Participants were adults from Australia, Belgium, Canada, France, Germany, Ireland, the Netherlands, Spain, Sweden, the UK, and the USA, with ALS symptom onset within 24 months of baseline. Patients with significant cognitive impairment, clinical dementia, psychiatric illness, other neurodegenerative diseases, or significant cardiac, hepatic, or renal disease were excluded. Patients’ blood levels of PUFAs were measured at the time of randomization. Death at 18 months and a joint-rank test that measured decline using the ALS Functional Rating Scale-Revised (ALSFRS-R) score and survival up to 12 months were used to determine clinical progression. The primary outcome was the association between PUFAs and ALS progression.

The results demonstrated that higher levels of one PUFA, alpha-linolenic acid (ALA), were associated with a slower functional decline in ALS patients, as evidenced by a lower risk of death and a higher joint-rank score. In contrast, higher levels of the monounsaturated fatty acid, palmitic acid, were associated with a higher risk of death. The study was limited by a lack of information regarding participants’ dietary patterns and whether blood levels of fatty acids accurately reflected dietary intake of fatty acids. Nonetheless, the results suggested that PUFAs may be beneficial in slowing clinical decline in people with ALS.

Image: PD

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